2017-2018 Confirmation Registration
Please fill out both sides of this form, print, sign and return it to the church office.
Student InformationLast Name First Middle Initial
/ Date of Birth
Address:
/ Student Cell Phone
Student e-mail School District Student Attends
Baptized? Yes No Date:______Where:______ / Received First Communion? Yes No Date:______Where:______
Will participate in Confirmation program
Graduation Year:______
6th grade 7th grade 8th grade 9th grade (Mentor Program)
Parent/Guardian Information
Parent’s (Guardian’s) Name
/ Member? Yes No
Telephone:
Home Cell
Available to volunteer? Yes No
If you are not a member of St. Mark’s, would you like to be contacted about joining St. Mark’s? Yes No
Parent’s (Guardian’s) Name [If different than above]
/ Member? Yes No
Telephone:
Home Cell
Available to volunteer? Yes No
If you are not a member of St. Mark’s, would you like to be contacted about joining St. Mark’s? Yes No
Other Vital Information
Snacks may be served occasionally—please indicate if there are any dietary restrictions or allergies
Photos are occasionally taken at church events to be used by St. Mark’s in promotional material including the website. Please let us know if you prefer that your child not be included.
Do not include in promotional photos
Registration Fee for Confirmation: $60.00 This covers the cost of program materials alongside special activities throughout the year. Confirmation Family Cap for fees $150 Fee included with registration. (Scholarships available)
2017-2018 Parent/Guardian Consent Form
Student’s name / Date of BirthInsurance Company / Policy Number
Doctor’s Name / Phone Number
Emergency contact #1 (Parent)
Name
Phone
Relationship to student
Emergency contact #2 (Someone other than a parent)
Name
Phone
Relationship to student
We, grant permission for ______to participate in all Confirmation ministry activities with St. Mark’s Lutheran Church in North St. Paul, MN for the 2017-2018 school year.
We believe that the participant is physically and mentally capable to participate in these events and understand that we will be responsible for picking up the above mentioned person if their behavior is disruptive, disrespectful or destructive.
We understand that the highest standards of safety will be upheld at these events, but in the case of an accident, we will assume the risk and responsibility of the above mentioned person is involved in an accident. The participant/ family will also be held responsible for accident or injury to any other party due to the participant’s behavior.
If we are not personally present at these events, in the case of emergency, St. Mark's is authorized on our behalf to arrange for such medical and hospital treatment as necessary for the health of the participant.
I authorize the participant to be transported by St. Mark's volunteers:
Parent (Guardian) Date ______
Please include any additional information (ie. physical challenges, learning challenges, social challenges) you feel would help us in providing the best experience for your student. All information will be kept confidential. You may also contact Pastor Ivy Huston directly by phone at 651-777-7451, ext 232, or at .
Please attach a check for $60 for each student
(payable to St. Mark’s, please put Confirmation 2017-2018 in the memo)
with this registration form when you return it to the church office as soon as possible.